颈部血管超声联合经颅多普勒超声与急性脑梗死颈动脉狭窄程度的关系及预后影响因素分析

Relationship Between Cervical Vascular Ultrasound Combined with Transcranial Doppler Ultrasound and Degree of Carotid Artery Stenosis in Acute Cerebral Infarction and Analysis of Prognostic Factors

目的:探讨应用颈部血管超声(CDU)联合经颅多普勒超声(TCD)对评价急性脑梗死(ACI)颈动脉狭窄程度的价值及预后影响因素。方法:选取2018年10月~2022年10月收治的ACI患者65例为研究对象,均接受CDU检查、TCD检查、数字减影血管造影(DSA)检查。以DSA检查为金标准,分析应用CDU检查、TCD检查、CDU联合TCD检查对ACI颈动脉狭窄程度的价值,对比不同狭窄程度患者检查参数指标。根据患者预后情况分成预后良好组与预后不良组,分析影响ACI预后相关因素。结果:DSA检查检出颈动脉狭窄50例(76.92%),轻度狭窄18例(36.00%)、中度狭窄17例(34.00%)、重度狭窄及完全闭塞15例(30.00%);颈动脉重度狭窄及完全闭塞者RI高于中度狭窄,中度狭窄高于轻度狭窄(P<0.05);颈动脉重度狭窄及完全闭塞者PSV、EDV、PI低于中度狭窄,中度狭窄低于轻度狭窄(P<0.05);CDU+TCD检查的诊断敏感度与准确度均高于单纯检查(P<0.05)。随访患者中预后良好44例,预后不良21例,经多因素Logistic回归分析表明年龄≥60岁、肥胖、合并高血压、合并糖尿病、合并高脂血症均是影响预后独立危险因素。结论:采取CDU联合TCD检查对诊断ACI颈动脉狭窄的准确度高,年龄、肥胖、合并疾病是影响患者预后的相关因素。

Objective:To investigate the value of cervical vascular ultrasound(CDU)combined with transcranial Doppler ultrasound(TCD)in the evaluation of the degree of carotid artery stenosis in acute cerebral infarction(ACI)and the prognostic factors.Methods:A total of 65 patients with ACI admitted from October 2018 to October 2022 were selected as subjects,all of whom underwent CDU examination,TCD examination and DSA examination.Using DSA examination as the gold standard,the value of CDU examination,TCD examination,CDU combined with TCD examination on the degree of carotid artery stenosis in ACI was analyzed,and the examination parameters of patients with different degrees of stenosis were compared.According to the prognosis of patients,they were divided into good prognosis group and poor prognosis group,and the relevant factors affecting the prognosis of ACI were analyzed.Results:50 cases(76.92%)of carotid artery stenosis were detected by DSA,18 cases(36.00%)of mild stenosis,17 cases(34.00%)of moderate stenosis,15 cases(30.00%)of severe stenosis and complete occlusion.The RI of severe carotid artery stenosis and complete occlusion was higher than that of moderate stenosis and moderate stenosis was higher than that of mild stenosis(P<0.05).The PSV,EDV and PI of severe carotid artery stenosis and complete occlusion were lower than moderate stenosis,and moderate stenosis was lower than mild stenosis(P<0.05).The diagnostic sensitivity and accuracy of CDU+TCD test were higher than that of simple test(P<0.05).In the follow-up,44 patients had good prognosis and 21 patients had poor prognosis.Multiple Logistic regression analysis showed that age≥60 years old,obesity,hypertension,diabetes and hyperlipidemia were all independent risk factors affecting prognosis.Conclusion:CDU combined with TCD is highly accurate in the diagnosis of ACI carotid artery stenosis.Age,obesity and complicated diseases are related factors affecting the prognosis of patients.